Healthcare Provider Details

I. General information

NPI: 1114924438
Provider Name (Legal Business Name): MEADOWS AT WESTFALL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 LAC DE VILLE BLVD
ROCHESTER NY
14618-5600
US

IV. Provider business mailing address

5901 LAC DE VILLE BLVD
ROCHESTER NY
14618-5600
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-7960
  • Fax: 585-442-6984
Mailing address:
  • Phone: 585-442-7960
  • Fax: 585-442-6984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2750306N
License Number StateNY

VIII. Authorized Official

Name: MR. DARYL DRADER
Title or Position: CONTROLLER
Credential: CFO
Phone: 585-442-7960